Estate Master Plan€¦ · 1. Introduction The Recommendations Report(vol. IV) developed for the Bermuda Hospitals Board (BHB) Estate Master Plan summarizes the further development

Estate Master Plan

Volume FourRecommendations Report

Vol4 Inner Cover.qxd 9/11/2005 7:35 PM Page 1

Table of Contents

1. Introduction ...............................................................................

2. Programme Summary................................................................a. Master Programme Summary.............................................................................

3. Acute Care Hospital ..................................................................a. Options ..................................................................................................................b. Evaluation / Recommendation.............................................................................c. Recommended Direction......................................................................................................

4. Campuses of Care .....................................................................a. Central Site..........................................................................................................b. West Site...............................................................................................................c. East Site...............................................................................................................

5. Mid Atlantic Wellness Institute .................................................

6. Continuing Care Facilities.........................................................

7. Staff Housing .............................................................................

8. Project Implementation.............................................................

9. Next Steps....................................................................................

IESTATE MASTER PLAN - RECOMMENDATIONS REPORT

4.1.1

4.2.14.2.2

4.3.14.3.14.3.354.3.39

4.4.14.4.24.4.54.4.7

4.5.1

4.6.1

4.7.1

4.8.1

4.9.1

II ESTATE MASTER PLAN - RECOMMENDATIONS REPORT

1. Introduction

The Recommendations Report (vol. IV) developed for the Bermuda Hospitals Board (BHB)Estate Master Plan summarizes the further development of the three Campuses of Care, StaffHousing, and the exploration of three site options for the Acute Care Hospital.

• Arboretum Site

• Botanical Gardens Site

• King Edward VII Memorial Hospital Site

Acute Care HospitalIn June 2005, in conjunction with Government, the BHB requested that the Estate Master PlanTeam gauge public opinion for the various Acute Care Hospital replacement options. Implementationschedules and cost estimates for each of the three options were also developed.

Public forums were conducted with BHB representatives and the general public in June and July(two BHB forums and six public forums). Surveys were conducted (via website, at the public forumsand via telephone) to document opinions for each of the three sites. Public support was greatestfor remaining at the King Edward VII Memorial Hospital site despite the many logistical and physicalchallenges and risks that would be associated with this option.

Upon review of all of the factors that affect the delivery of quality healthcare to Bermuda, theProject Steering Committee reinforced that the Arboretum Site would best serve the long-termneeds of healthcare as originally selected. However, it was also recognized that time is of theessence, and due to considerable public opposition to using any parkland for a hospital site, theprudent decision would be to develop a Replacement Hospital on the existing King Edward VIIMemorial Hospital Site. In July 2005, the Bermuda Hospitals Board endorsed this recommendation.

It is important to note, however, that there are considerable risks associated with constructinga new Replacement Hospital on the KEMH site, while keeping the existing facility in operation.In addition, a plan must be implemented as soon as possible to relocate the existing ContinuingCare Facility and Nurses Residence in order to begin construction of the Replacement Hospital.

4.1.1ESTATE MASTER PLAN - RECOMMENDATIONS REPORT

Arboretum Site

King Edward VII Memorial Hospital Site

Botanical Gardens Site

1. Introduction

Campuses of CareThe development of "Campuses of Care" is a critical component to achieving a comprehensiveEstate Master Plan that addresses the total continuum of care for the citizens of Bermuda.Significant benefits of this “satellite facilities” approach include:

• Healthcare delivery is expanded throughout the island

• Services are closer to the patients, family, and caregivers

• Dispersed facilities can better respond to potential natural disasters

• Routine medical care can be provided outside of an "Emergency" environment

• Continuing Care Facilities are better suited in a community setting

• Group Homes are better suited in a community setting

Three sites were identified for further development evaluation:• Central Campus - Mid-Atlantic Wellness Institute Site

• West Campus - Port Royal Site

• East Campus - Southside St. David's Site

The East and West representative sites are owned by the Bermuda Land Development Corporation(BLDC). Further investigation will be required before a final site is chosen for development. Thelarger Central site is already owned by the BHB and could be developed quickly. Each of thecampuses will accommodate a 10,000 SF Primary Care Centre, 60 - 72 bed Continuing CareFacility, and Mental Health Group Homes that will house 60 patients.

Mid-Atlantic Wellness InstituteThe Central Campus site is sufficient in size to accomodate the Replacement Hospital for theMid-Atlantic Wellness Institute. Because the current Mental Health Hospital has excess space,a phasing plan can be implemented that would allow for the new Replacement Hospital to beconstructed north of the main building complex.

Continuing Care FacilitiesThe Continuing Care Facilities will be single-story, twelve-bedroom units with the ammenitiesof home. The units will be organized around resident gardens.

4.1.2 ESTATE MASTER PLAN - RECOMMENDATIONS REPORT

Central Campus

West Campus

East Campus

1. Introduction

Staff HousingThe Bermuda Hospitals Board (BHB) owns the site immediately north of Berry Hill Road to thenorth of the King Edward VII Memorial Hospital site. It is proposed that this site be used todevelop Staff Housing. Its close proximity to the Hospital is a definite advantage, and itstopography, while acceptable for housing, does not lend itself to be used for an Acute Care Hospital.

ScheduleThe Estate Master Plan implementation schedule will require at least 7 - 8 years to complete.Development of the new Acute Care Hospital on the King Edward VII Memorial Site will requirethat the Continuing Care Facility, and Nurses Residence be relocated and then demolished. Asa result, construction will not be able to begin on the Acute Care Hospital until 2009, with an openingdate scheduled for mid 2014.

The Planning and Design phases for the proposed scope of work are expected to continue tothe end of 2007. Pre-Design Services are scheduled to begin no later than January, 2006.Facilities Design will occur during 2006 and 2007. There are a number of potential opportunitiesto streamline and shorten the implementation process. This will require a detailed examinationof interim solutions for Continuing Care and Staff Housing.

CostThe current estimated Capital Cost (including equipment and duty but not including escalationand risk) in 2005 BMD dollars for implementing the entire Estate Master Plan is approximately$721 million. The programme components include:

• Acute Care Hospital $ 505.8 million

• Medical Office Building $ 40.9 million

• Mental Health Hospital and Group Homes $ 70.0 million

• Continuing Care Facilities (3) $ 75.5 million

• Staff Housing $ 28.6 million

Reference should be made to PriceWaterhouseCoopers’ Bermuda Hospitals Board EstateMaster Plan Business Case which has been prepared independently from the Estate Master Plan.The Business Case includes cost figures that include escalation and risk.


1. Introduction

It should be noted that the construction cost estimates are based on a Pre-Schematic andMaster Facilities programme documents and are not a completed set of working drawings thatwould be utilized by a contractor to bid the project. The estimates provide reasonable costenvelopes within which facility designs can be developed. Further cost estimates based on moredetailed design and engineering information may vary from this baseline estimate.

Next StepsThe Estate Master Plan as described in these documents does not represent a final detailedprogramme, organizational plan, or design concept. It outlines the new and exciting vision anddirection that the BHB will use to guide the future development of a more integrated healthcaredelivery model for the citizens of Bermuda. With Government approval of the plan, the followingcritical next steps must be undertaken before final design can commence:

• Determine sites for the relocation of the Continuing Care Facility and Nurses Residence

• Evaluate Alternative Operational Models within an integrated system

• Develop a detailed room-by-room Functional Programme

• Prepare a detailed Risk Assessment study

• Revise the Estate Master Plan concept designs based on the final programme

• Finalize the project scope and cost based on the final programme and design

• Determine the final funding and procurement process

The Estate Master Plan has been a diligent and very open and inclusive process. Multipleoptions were explored and reviewed with staff, physicians, agencies, and the general public onnumerous occasions. It is the desire of the BHB to continue the momentum and move quicklyinto the next phase of planning and design.


2. Programme Summary

During September and October 2004, Cannon Design assisted BHB in developing the preliminaryspace planning programme for the Estate Master Plan for the Bermuda Hospitals Board (BHB).Medical Planners from Cannon Design met with senior BHB leadership and stakeholders to discussunderstand and establish key strategic initiatives and operational goals of BHB services for thefuture. To ensure that the BHB space allocations meet future needs, the planning team reviewedhistorical workload volumes provided by BHB. A patient volume and bed demand capacityanalysis and projections for FY 2020 were prepared based on the anticipated Bermuda populationgrowth projection and to take into consideration the specific concerns and profile of Bermudaas well as address current trends anticipated in the delivery of healthcare in the future. Parametersfor the programme requirements were benchmarked against other community hospitals in theUnited States, Canada and Great Britain.

In coordination with this task, Cannon Design also interviewed department staff representativesand toured all BHB facilities and service lines at King Edward VII Memorial Hospital and TheMid-Atlantic Wellness Institute in order to understand the BHB current care delivery system/models,anticipated changes for service delivery for the future, as well as information on daily operationsand staffing.

Based upon BHB review and approval of the workload data and projections and the approvedoperational concepts, Cannon Design developed the preliminary space progamme (by departmentand facility). Next steps include conducting planning sessions for identification and discussionof options based on the established philosophy and overall planning concepts with an emphasison anticipated future methods of care delivery and flexibility for future growth and expansion.


2. Programme Summarya. Master Programme Summary

Programme/Service

Acute Care Replacement Hospital

Diagnostic Services 60,395 89,435 8,309 Includes Radiation Oncology

Ambulatory Services 16,410 28,775 2,673

Inpatient Services 67,665 107,210 9,960 ICU adjusted to 10 beds from 8 beds.

Support Services 21,245 30,200 2,806 Does not include FS, LAUN, MAT MGMT & STOR.(below)

Total Department Gross Square Feet 165,715 255,620 23,747

35% Bldg Grossing Factor provided (average/best use) 1.35 1.35

Total Building Gross Square Feet 416,253 345,087 32,059

BHB System Support Centre

Food Services - Food Preparation / Storage 9,930 8,000 743

Laundry 7,105 7,160 665

Materials Management 9,485 12,270 1,140

Storage - Long Term 5,940 6,000 557

Total Department Gross Square Feet 32,460 33,430 3,106 Existing Area incl. In Acute Care Hospital


Total Building Gross Square Feet 40,116 3,727

Medical Office Building

Administrative Services 31,135 45,555 4,232 Existing Area incl. In Acute Care Hospital

Ministry of Health Administrative Services 20,000 20,000 1,858 Existing Area to be verified.

Physician Office Space 0 60,000 5,574




CommentsExisting

DGSF

Proposed

DGSF

Proposed

DGSM



Programme/ServiceComments

Existing

DGSF

Proposed

DGSF

Proposed

DGSM

Mental Health Campus

Acute Psychiatric Inpatient (19 + 6 Beds) 10,869 11,250 1,045

Longterm Psychiatric Inpatient (18+24 Beds) 41,486 21,350 1,983

Detox Inpatient Unit (10 Beds) 1,360 3,150 293

Outpatient Services & Clinics 32,340 36,995 3,437

Administrative Services 10,530 12,120 1,126

Support Services 11,335 13,265 1,232




Continuing Care Campus

Existing

Continuing Care 33,785 Existing Area incl. In Acute Care Hospital

Dementia Care Beds 9,075 Existing Area incl. In Acute Care Hospital

Proposed

Continuing Care Campus West - 72 Beds

6 Houses - 12 Beds each 24,210 2,249

Resident/Staff Services 5,210 484

Administrative Services 2,580 240

Support Spaces 3,960 368






Existing

DGSF

Proposed

DGSF

Proposed

DGSM

Continuing Care Campus Central - 60 Beds

5 Houses - 12 Beds each 20,175 1,874






Continuing Care Campus East - 60 Beds

5 Houses - 12 Beds each 20,175 1,874






Mental Health Group Homes (Learning Disability)

Group Homes (11 Units = 55 Beds) 15,830 24,750 2,299 Existing Area incl. In Mental Health Campus






Existing

DGSF

Proposed

DGSF

Proposed

DGSM

Primary / Urgent Care Centre

West Location 10,000 929

East Location 10,000 929



Staff Housing

Studio Unit (36 Units) 24,231 18,000 1,672

One Bedroom (25 Units) 16,250 1,510

Two Bedroom (6 Units) 6,000 557

Three Bedroom (6 Units) 7,200 669

Twelve Unit Guest House 3,825 355



Total Gross SF / SM 623,516 916,971 85,187



3. Acute Care Hospitala. OptionsIn June, 2005, the BHB, in conjunction with Government, requested that the Estate MasterPlan Team develop Acute Care Hospital options in further detail at the following sites:

• Arboretum Site• Botanical Gardens Site• King Edward VII Memorial Hospital Site

The Team facilitated six public forums and two BHB forums during June and July to explain thevarious options and to then gauge public opinion for the options. Surveys were conducted viawebsite, at the public forums, and via telephone sampling.

The evaluation of the three sites included a review of the following material:

• Site Plan(s)• Floor Plans• Site / Building Section• Implementation Schedule• Cost Estimate• Strengths and Weaknesses Summary• Qualitative Risk• Objective / Benefit Matrix

Each site option is documented on the following pages.


Arboretum Site

Botanical Gardens Site

King Edward VII Memorial Hospital Site

3. Acute Care Hospitala. OptionsThrough the interview and facility tour process, BHB stakeholders and department representativesidentified program and service planning initiatives to be considered to be incorporated into theoptions for the Estate Master Plan. Listed below are the planning concepts that are commonto each option developed to date.

Administration / Public• Consolidate Intake Services including Registration/Admitting, Pre-Admission Testing (PAT)

and Blood Draw in one location to provide one-stop service, reducing multiple servicelocations that exist; and excessive patient travel routes.

• Locate Public Services along the public concourse to include a Retail Pharmacy, CoffeeShop, Gift Shop and Credit Office.

• Locate and expand Health Education Services including classrooms and the Medical Libraryare convenient to the front door to emphasize commitment to community education.

Diagnostic Services• Configure high volume Outpatient Services such as Medical Outpatient Clinic, Wound Care

/ HBO, Dialysis and Infusion Therapy with convenient outpatient access.

• Develop Infusion Therapy and Oncology Services in a consolidated Oncology/InfusionTherapy Centre and efficiently utilize/share support space

• Locate and configure Dialysis and Infusion Therapy areas serving longer length of visitpatients with maximized exterior views.

• Conveniently locate Rehab/Physiotherapy to the central lobby or designated entrance withdirect patient drop-off / pick-up; this area is also directly linked to the Rehab inpatient unit.Functionally group the Orthopedic Clinic adjacent to Physiotherapy/Rehab to minimizepatient travel distances and support Limb and Brace Clinic concept.

• Emergency walk-in patients and ambulance access will be separated from general traffic uponarriving on the site and have separate entrance to the Emergency Department.

• Develop a Diagnostic Hub that accommodates Imaging/Radiology, Surgery/Endoscopy andCardiology immediately adjacent to Emergency Department in a consolidated layout. Developprocedure areas and the main Surgery Suite based on the concept of a flexible diagnosticzone where various Diagnostic Services may be developed to cross-utilize procedure spaceas patient acuity and technology enable this concept. (i.e. future Invasive Cardiology).Organizationally, Sterile Processing is located immediately adjacent to the Surgery Suite.

• Develop an Asthma/Diabetes/Respiratory Centre functionally located adjacent with Cardiologyand CHF.


3. Acute Care Hospitala. OptionsInpatient

• Typical Medical/Surgical Unit provides 32 beds.

• Each private or semi-private patient room will have an attached private patient toilet roomwith a shower, (Proposed: 100% ADA accessible.) and be sized for family member sleep-in, medical equipment, and TV/armoire.

• The Surgical Unit (36 beds required on a 32 bed unit) is located adjacent to the Rehab Unit(24 beds required on a 32 bed unit) in order to enable swing capacity to accommodateSurgical unit overflow as needed.

• The Surgical Unit is located with direct access to the Surgery Suite; the Rehab Unit isvertically linked to the Rehab/Physiotherapy Department.

• Patient rooms have been sized and configured for patient, staff and family areas accommodatingsleeping-in. The patient will be able to control window shading, interior lighting, and roomtemperature.

• Room finishes will be residential in character. Built-in cabinetry, concealed lighting, furniture,and artwork will be chosen to create a warm, comfortable, "hotel-like" feeling.

• The nursing units will all be oriented towards the Arboretum. Large expanses of glass offerpanoramic views of the park and provide natural light to each patient room.

• Internally, circulation for services that may accommodate limited inpatients or support serviceswill utilize designated elevators provide discreet access to/from upper floors.

Support• Support Services located towards the “back of facility” will utilize a designated service

entrance include: Material Management, Laundry, Environmental Services, Food Services,Pharmacy and Bio-Med are located on a service corridor. Staff dining is accessed off thepublic/general use corridor.

• The Support Service zone is configured for direct access for delivery vehicles as well as directdistribution of supplies to the facility without mixing traffic with patients and public users.


3. Acute Care Hospitala. Options - Arboretum SiteThe Arboretum open space will form an identifiable entrance zone from both the west andsouth boundaries. When viewing the new hospital, one's eyes will be instantly drawn to the arboretumin front of it. Built into the steep slope of the north edge, the building becomes an extension ofthe natural topography, not an object on it. All of the nursing units will be oriented to the centralgreen space.

A stone-lined access road from both Montpelier Road and Middle Road will gently lead to a drop-off area at the centre of the site, providing a serene arrival point for all patients and visitors. Allvehicle parking will be accommodated within a parking deck that is also built into the existingslope. Emergency access and parking will be separated upon arrival to the site. Service vehicleswould access the facility from the back of the proposed building, along Fort Hill Road.

The public will still be able to access the majority of the front grounds that will be furtherenhanced with paved walking paths and additional planting. The serene inland setting of openspace, conifers, palms, meadows, and interesting plants and shrubs will be maintained. TheDeputy Governor's Residence at the corner will also not be disturbed.

Spiritually, the green park will remain the very heart of the campus and signal the commitmentof the Bermuda Hospitals Board to the creation of a total healing environment. Within the widercontext of the site, the Arboretum will continue to be part of the network of green spaces thatare vital recreation and leisure resources to the citizens of Bermuda.

The New Acute Care Hospital, a natural extension of the existing topography and sedimentaryrock formation, will be perceived as a series of horizontal, landscaped terraces. The ridge thatruns along the north side of the site has a 20-meter drop that will allow for the fluid integrationof four programme levels.

Natural light will be brought into the interior of the support levels through skylights that arelocated on each of the terraces. Each nursing station, located at the corner of the triangular patientunit, is expressed on the exterior of the building as a glass corner, offering fabulous views ofthe park to the staff as well as patients and family members.

The base of the facility will utilize natural Bermuda stone. Large expanses of glass, used to integratethe interior spaces via views to the Arboretum, will be "reflective" in order to further diminish theimpact of this building on the site.


Site Plan

3. Acute Care Hospitala. Options - Arboretum Site


Fort Hill Road

Arboretum

Montpelier R

oad

Middle Road

Ground LevelThe Ground Level serves the main arrival entrance to the facility, providing high volume outpatientservices, intake services and public/education services convenient to the main entrance.

• Patients can access this level and services if dropped of by car, or from designated parkingdeck located directly adjacent to these services areas.

• Outpatient services such as Medical Outpatient Clinic, Wound Care / HBO, Dialysis andInfusion Therapy are configured for convenient outpatient access.

• Rehab/Physiotherapy are located with direct patient drop-off / pick-up and parking accessfor disabled Rehab patients; this area is also linked to the Rehab inpatient unit above. TheOrthopedic Clinic is also located adjacent to Rehab to minimize patient travel distances.

• Intake services including Registration/Admitting, Pre-Admission Testing and Blood Draware consolidated in one location to provide one-stop service.

• Public services clustered along the public concourse include a Retail Pharmacy, CoffeeShop, Gift Shop and Credit Office and Education.

Level 1Level 1 serves as the main diagnostic hub as well as the support chassis for the new facility.The plan is developed in two distinct zones that clearly separates patient diagnostic areas fromsupport areas with defined circulation system; while also proving direct access from support zonesto directly supply diagnostics as needed.

• General patient access is accommodated via the main entrance below or via parking deckinterstitial level with elevators that directly transport patients to points of care.

• The Diagnostic Hub accommodates: Imaging/Radiology, Surgery and Cardiology are locatedimmediately adjacent to Emergency Services in a consolidated layout.

• Sterile Processing is located directly below the Surgery Suite and is connected by designatedvertical circulation.

• Cardiology is also developed in coordination with a designated Asthma/Diabetes/RespiratoryCentre located immediately adjacent.

• Laboratory and Pathology is centrally located in the facility to support all intake and diagnosticservices and inpatient units as well as convenient to the exterior for courier access.





Level 1


Ground Level


Level 2

• Intensive Care Unit is located directly above the Emergency Department, the Surgery Suiteand Diagnostics for direct transport of the high acuity patients.

• Two Medical Hub Units are provided; they are located adjacent to the ICU in order to serveas a step-down unit for appropriate medical patients when required.

• Maternity and Paediatrics are located in a designated inpatient pod with distinct separationfrom the general Medical/Surgical units.

• Agape Beds are located in a freestanding home-like setting but are physically attached tothe main Hospital via patient corridor.

• Medical Management programmes Health Records and Medical Staff Services for physiciansare located on the main circulation spine connecting all services.

Level 3

• Surgical Unit is located directly above the Surgery Suite.

• The Rehab Unit (24 beds) is located adjacent to the Surgical Unit (36 beds required) in orderto flex to accommodate Surgical unit overflow as needed; the Rehab is also verticallyconnected to the Rehab/Physiotherapy Department.

• Inpatient elevators provide discreet access from upper floors and connect to these serviceareas.

• Ministry of Health administrative space is configured as an inpatient care pod, to accommodatefuture growth of inpatient beds if required.





Level 3

Level 2

3. Acute Care Hospitala. Options - Arboretum SiteImplementation Schedule

The Planning and Design phases for the proposed scope of work will continue into the beginningof 2007. The final Estate Master Plan documents will be completed in September, 2005. Thepreparation of a detailed Functional Programme will require approximately 6 months. It isexpected that Facilities Design will occur during 2006 and the first quarter of 2007.

Construction of the Replacement Hospital at the Arboretum site could begin as early as the secondquarter of 2007 and be completed by the end of 2010. The construction of the Continuing CareFacilities, Group Homes, Primary Care Centres, and new Mental Health Hospital could occurat any time during the same period if funding were in place and cash flow was adequate.Demolition of the existing King Edward VII Memorial Hospital would be scheduled during 2012.

All components of the Estate Master Plan would be implemented by the end of 2012, which iswithin the critical period identified during the Comprehensive Strategic Review.






Strengths:

• No disruption or negative impact on the existing operations or patients• Equivalent area of KEMH site returned to Government as Open Space (no net loss of park

space)• (70%) Majority of the Arboretum will remain• Distinct separation of service access from public and patient access• Potential to incorporate Qualities of Healing Environment into a Garden Setting• Building perceived as two levels from north and east• Completed 2010 (within critical stage identified and with a two year contingency)

Weaknesses:

• Requires long-term use of part of Arboretum Site• Increases traffic on Middle Road and Montpelier Road• Partial disruption of Arboretum Site during construction (4 years)• Additional institutional development in the area

Qualitative Risk:

One significant strength of the AR.A - "Garden Terrace" Option is that it presents few (if any) QualitativeRisks or disruption to the ongoing operation of the existing hospital. Given that construction wouldbe occurring on a greenfield site that is not adjacent or in close proximity to the existing hospital.



3. Acute Care Hospitala. Options - Botanical Gardens SiteThe Botanical Gardens' existing landform and landscape influences every aspect of theproposed site organization for the new hospital. The formal garden and specimen trees alongthe western boundary of the site are the inspiration for the new and enriched formal landscapethat will extend along the western side of a new central courtyard. The formal lawn will celebrateone's arrival and departure, and also provide a new open space within the Botanical Gardensfor contemplation and reflection.

The main entrance and public spaces begin opposite a reflecting pond and then extend throughthe building to a multi-story "conservatory" that separates two terraced nursing units. A two-storyadvanced technology diagnostic centre links the two patient wings. The roof becomes anexpansive garden used for contemplation, therapy and recreation. Patients, visitors, and staffwill be able to overlook the formal courtyard to the west and the Botanical Gardens to the east.Strategically located skylights will also allow natural light to penetrate the interior spaces of thefloors below.

A heavily planted landscape buffer, adjacent to the southern terraced roof garden, will providea very compatible transition from the existing single-family homes to the new patient residences.Underground parking is provided at the southern end of the courtyard adjacent to the mainentrance. The terraced structure will be sculpted to integrate with the falling landform andlocated to protect some of the Botanical Gardens' most treasured trees to the southwest.

Within the wider context of the entire Botanical Gardens site, the proposed land use will continueto provide a network of green spaces that are vital resources to the Bermuda citizens.

The New Acute Care Hospital is organized along the formal entrance lawn by a linear, slottedstone wall that defines the edge of the multi-story diagnostic centre. A continuous glass wall atgrade strengthens the visual connection between the inside spaces and the outdoor landscaping.The bold cantilevered roof structure is an expression of the main entrance and its linkage to theConservatory beyond.

The Conservatory will become the "heart" of the facility's public spaces. It is enriched withnative landscaping and floral gardens familiar to all Bermudians, and will provide spectacularviews into the gardens and beyond. The Conservatory encloses a circulation hub that willprovide dedicated vertical and horizontal circulation within the new facility for patients, public,and service movement. The upper levels of the Conservatory will house family and educationalsupport spaces that are shared between both nursing wings. Access to the public rooftop gardenwill provide a direct connection to experience Bermuda's unique climate and landscape.


3. Acute Care Hospitala. Options - Botanical Gardens Site


Botanical Gardens

South Road

Berry Hill Road

Point Finger Road

3. Acute Care Hospitala. Options - Botanical Gardens SiteGround LevelGround Level serves as the support chassis for the new facility which includes Support Servicesand the Central Utility Plant.

• Administrative support services include Health Records, Information Services HumanResources and Employee Health, EAP, and QA/IC near public elevators.

• Material Management, Laundry, Environmental Services, Food Services and Pharmacy arelocated on a service corridor. Staff dining is accessed off the public/general use corridor.

• Laboratory/Pathology is located on this level with the Morgue function attached to the mainLaboratory with convenient access to the exterior for courier access. Elevators and pneumatictube will connect the Laboratory and Pathology to all intake and diagnostic services, and inpatientunits.

• The Support Service zone is configured for direct access for delivery vehicles as well as directdistribution of supplies to the facility.

• Staff access is also provided to this level via connected parking deck.

• Shell space is also provided for future growth.

Level 1Level 1 serves the main arrival entrance to the facility, providing high volume outpatient services,intake services and public/education services convenient to the main entrance, while providingclear and direct access to other patient service areas.

• Upon arrival, patients enter the main lobby central to outpatient services and public/educationservices. A public elevator hub is provided in the Lobby separate from the designated patientand support elevators.

• Administrative Space accommodates Finance and the Ministry of Health.

• Maternity and Pediatrics are located on a secured patient corridor linked to DiagnosticsCentre one floor above.




Level 1Ground Level

3. Acute Care Hospitala. Options - Botanical Gardens SiteLevel 2Level 2 serves as the main diagnostic and surgical centre of the new facility.

• The plan locates separate public elevators and outpatient circulation in the main diagnosticzone while a designated patient/support corridor links the Diagnostic/Surgical zone to the Surgicaland Rehab inpatient zone. Designated inpatient elevators on this corridor located on thiscorridor connect to the upper floors.

• Emergency walk-in patients and ambulance access will be separated from general traffic uponarriving on the site and have separate entrances to the Emergency Department.

• The Diagnostic Hub accommodates: Imaging/Radiology, Surgery/Endoscopy and Cardiologyare located immediately adjacent to Emergency Services in a consolidated layout. SterileProcessing is located immediately adjacent to the Surgery Suite.

• Cardiology is also developed in coordination with a designated Asthma/Diabetes/RespiratoryCentre located immediately adjacent.

• Surgical Unit is located directly adjacent to the Surgery Suite.

• The Rehab Unit (24 beds) is located adjacent to the Surgical Unit (36 beds required) inorder to flex to accommodate Surgical unit overflow as needed; the Rehab is also verticallyconnected to the Rehab/Physiotherapy Department.

Level 3• Intensive Care Unit (ICU) is centrally located directly above the Diagnostic/Surgical Centre

and Emergency Department for direct transport of the most critical patients.

• Two Medical Units are provided; they are located adjacent to the ICU in order to serve as astep-down area for appropriate medical patients.

• Note: Agape Beds are located in a freestanding facility in a home-like setting and is not attachedto the main Hospital.




Level 3Level 2

3. Acute Care Hospitala. Options - Botanical Gardens SiteImplementation Schedule


Construction of the Replacement Hospital at the Botanical Gardens site could begin as earlyas the second quarter of 2007 and be completed by the end of 2010 as long as the existing BotanicalGardens' buildings are relocated and demolished within the next 18 months. The constructionof the Continuing Care Facilities, Group Homes, Primary Care Centres, and new Mental HealthHospital could occur at any time during the same period if funding were in place and cash flowwas adequate. Demolition of the existing King Edward VII Memorial Hospital would be scheduledduring 2012.

All components of the Estate Master Plan would be implemented by the end of 2012, which iswithin the critical period identified during the Comprehensive Strategic Review.



2016201520142013201220112010200920082007200620052004

Planning & DesignEstate Master Plan

Detailed Functional

Programme

Facilities Design

Implementation

Acute Care Hospital

Demolish Existing Hospital

Campus of Care (Central)

Campus of Care (West or East)

Campus of Care (East or West)

Mental Health Facility

Relocate Buildings from

Botanical Gardens




Strengths

• Minimal disruptions or negative impact on the existing operations or patients• Allows timely delivery of Hospital (not impacted by Continuing Care)• Potential to incorporate Qualities of Healing Environment into a Garden Setting• Front Garden area (existing KEMH site) becomes public park setting• Completed 2011 (within critical stage identified

Weaknesses

• Environmental Sensitivity to taking over part of Botanical Gardens site (approx. 35%)• Requires relocation of Botanical Gardens, existing Ministry of Environment and Parks

Department Buildings, Exhibition Halls and Riding/Show Arena• Premium cost (approx. 5%) due to relocation of buildings

Qualitative Risk:

While the qualitative risks associated with the BG.A "Quadrangle" Replacement Hospital on theBotanical Garden Site are much less than on the KEMH site, there are however risks that shouldbe considered. These include:

• Significant Noise Control Disruption• Airbourne Particles / Infection Control Concerns• Vibration and its Effect on Hospital Services


OBJECTIVE BENEFIT LOW SCORE CRITERIA 0 10 # HIGH SCORE CRITERIA

AFFORDABILITY

Site Availability High $ Cost 2 No Cost $ to BHB

Total Project Cost High Project $ Cost 7 Low project $ Cost

TIMELINESS

Schedule to Completion 15 years 7 5 years

Project Implementation Risk Delays 4 No Delays

QUALITY OF CARE

Impact on Current operations Disruptions 8 No Disruption

Impact on Patients Decreased Confidence/Use 8 Increased Confidence/Use

Programme Requirements Compromised 9 Meets Needs

EFFICIENCY

Functional Layout Compromised 9 Preferred

Future Flexibility No Flexibility 6 Easily Expanded/Renovated

Movement Long Travel Distances 7 Short Travel Distances

DESIGN IMAGE

Site Image Negative Impact 9 Positive impact

Building Image Institutional 9 Healing Environment

FINANCE

Revenue Potential Lost Revenue 8 Increased Revenue

Operational Costs Increased Costs 7 Decreased Costs

Ability to Fundraise Status Quo/Long Delivery 8 New Image/Timely Delivery

PUBLIC ACCEPTANCE

BHB Internal User Group Low Acceptance 3 High Acceptance

General Public Low Acceptance 2 High Acceptance

External Agencies/Gov't Low Acceptance 8 High Acceptance

Physician Community Low Acceptance 7 High Acceptance

TOTAL 47 MAXIMUM SCORE (70)

7.33

9.00

7.67

5.00

4.50

5.50

8.33

SCORE


3. Acute Care Hospitala. Options - King Edward VII Memorial Hospital SiteThe placement of the new Acute Care Hospital on the existing King Edward VII MemorialHospital Site establishes a western and northern edge to a new central open space that will becomethe focal point for arrival. Structured parking occupies the east side of the central courtyard, leavingthe south side open for visual and physical connection to the Botanical Gardens. The centralcourtyard will gently slope upward towards the building to provide main entrances for the Hospitalas well as Women's Center off of the large round-about. The central courtyard is intended tobecome an extension of the Botanical Gardens, creating a natural environment on all levels ofthe new hospital.

Access to the site will occur from the southwest corner off of Point Finger Road and the northeastcorner off of Berry Hill Road. This arrangement will allow the existing facility to remain in placeand operational until the new facility can be brought on line. The crescent shape of the west wingof the new hospital follows the profile of Point Finger Road. The simple crescent form is benchedinto the steep existing slope, providing access from the south at the ground level and from thenorth at the upper level. All back-of-house support services are organized along the north sideof the facility with direct access from the service entry of Berry Hill Road.

The Emergency Department is located on the upper level with a dedicated entry and parkingfrom Berry Hill Road. A separate Medical Office Building is planned for the southwest cornerof the site adjacent to the other physician offices along Point Finger Road.

The three-storey massing of the facility allows all programme elements to have direct andmeaningful contact with the natural landscape. All of the inpatient units are organized on a singlelevel along the crescent and linked together with a public colonnade that overlooks the centralcourtyard. Lower scale pavilions along the colonnade provide a comfortable human scale thathelps to disguise its institutional function.

The nursing units will all be oriented towards the Hamilton Harbour. Large expanses of glasswill offer panoramic views and provide natural light to each patient room. The rooftop terraceswill provide pleasant settings for patients and visitors to interact. Skylights in the terraced roofallow natural light to penetrate the interior spaces of the floor below. Vertical circulation at theapex of the patient units provides easy and uniform access to all program spaces and capturedopen space within the facility.


3. Acute Care Hospitala. Options - King Edward VII Memorial Hospital Site


Botanical Gardens

Berry Hill Road

Point Finger Road

ExistingHospital

3. Acute Care Hospitala. Options - King Edward VII Memorial Hospital SiteGround LevelThe Ground Level provides consolidated outpatient services along the public building face andalso houses the components that make up the support chassis of the Hospital to the rear of thefacility.

• A central main entrance serves the entire facility. Surface parking is immediately adjacent.Upon entry, high volume Outpatient Services and Public/Education service visitors are peeledoff from the main lobby and other patients and visitors are directed to designated elevatorsproviding direct access to the diagnostic hub and the inpatient units.

• Internally, inpatient and support is clearly separated from public with designated elevators.

• Laboratory/Pathology is located on this level with convenient access to the exterior forcourier access. The morgue function is located convenient to the Lab, but located closer tothe dock area. Elevators and pneumatic tube will connect the Laboratory and Pathology toall intake and diagnostic services, and inpatient units.

Level 1Level 1 centralizes the diagnostic hub in the juncture of the "L" shaped plan of the new facility.The plan also accommodates administrative services on the perimeter of each leg of the "L" shapedplan.

• On this level Emergency Department access for walk-in patients and ambulance accesswill be separated from general traffic upon arriving on the site.

• Interior circulation is managed by two distinct parallel corridors separating high volumeoutpatients and public from acute patient and clinical support circulation areas. As well aszone the diagnostic areas from the administrative areas.

• The Diagnostic Hub consolidates Imaging/Radiology, Surgery and Cardiology in one locationis located immediately adjacent to Emergency Services.

• Administrative support services include Health Records, Information Services, Finance,Human Resources and Employee Health, Executive Administration and multiple medicalmanagement services.

• The Chapel is located with convenient access to the Emergency Department and Surgeryas well as vertically convenient to the ICU.

• The main public concourse also connects to the future Medical Office Building.




Level 1Ground Level

3. Acute Care Hospitala. Options - King Edward VII Memorial Hospital SiteLevel 2

• All inpatient beds are accommodated on one level.

• Typical inpatient units are planned based on a 32 bed unit model.

• Intensive Care Unit (ICU) is located directly above the Emergency Department, the SurgerySuite and diagnostic zone for direct transport of the most critical patients. ICU is also centralto all inpatient units.

• Two Medical Units are provided; they are located adjacent to the ICU in order to serve as astep-down area for appropriate medical patients.

• Surgical Unit is located directly above the Surgery Suite.

• The Rehab Unit the Rehab is vertically stacked above the Rehab/Physiotherapy Department;although not immediately adjacent to the Surgical Unit (36 beds required); Rehab may flexto accommodate Surgical unit overflow as needed;

• Maternity and Pediatrics pavilion is located in a separate inpatient tower with distinct separationfrom the general Medical/Surgical units; proposing the development of a separate identityfor Women's Services Centre.

• Inpatient elevators provide discreet access from upper floors and connect to these serviceareas.

• Agape beds are located in a freestanding home-like setting but are not physically attachedto the main Hospital.




Level 2



Implementation Schedule


Construction of the Replacement Hospital at the existing KEMH site can not begin until theexisting Continuing Care Facility and Nurses Residence are relocated in order to gain accessto the site for the proposed new construction. A timely decision regarding the relocation sites,project funding source, and operational/ownership model is extremely critical to implementingthe Estate Master Plan schedule.

Continuing Care Facilities (132 beds total) must be developed on two of the Campuses of Careas soon as possible. The Nurses Residence would be relocated to the KEMH site across thestreet from the main hospital (assuming that the staff parking can be temporarily relocated tothe Botanical Gardens' arena site). The earliest feasible date for opening these new facilitiesis the first quarter of 2008. Prior to the demolition of the facilities, however, the Central UtilityPlant connections to the existing hospital must be relocated.

As a result, construction on the new acute care hospital would not be able to begin until the thirdquarter of 2009. The hospital could be occupied by the beginning of 2013. Demolition of theexisting hospital would occur later that year, with final construction of the new staff and patientparking structure completed by 2015.

The construction of the remaining Continuing Care Facility, Group Homes, Primary Care Centres,and new Mental Health Hospital could occur at any time during the same period if funding werein place and cash flow was adequate.

All components of the Estate Master Plan would be implemented by the end of 2015, which isthree years beyond the critical period identified during the Comprehensive Strategic Review.


2016201520142013201220112010200920082007200620052004

Planning & DesignEstate Master Plan

Detailed Functional

Programme

Facilities Design

Implementation



Relocate Nursing Residence

Demolish Cont.Care, C.U.P.

& Nursing Residence

Acute Care Hospital



Rework Plant Connections



Strengths

• Maintains existing site location with minimal land acquisition• Adjacent to current healthcare community of Physicians and Agencies• Road network can accommodate Hospital traffic

Weaknesses

• Requires acquisition of part of the Botanical Garden site (construction staging & packing)• Significant Hospital disruption due to site work in and around existing hospital• Extended Schedule for completion due to phasing (4-5 yrs) is beyond identified critical stage• Premium cost due to extended schedule• Requires immediate implementation of Campuses of Care (Continuing Care Component)

Qualitative Risk:

It is important to note that there are considerable risks associated with the KE.C. "Crescent" ReplacementHospital Option. These include but are not limited to both quantitative and qualitative risks(refer to separate PriceWaterhouseCoopers Report regarding the Quantitative Risks). Theprimary Qualitative Risks include:

• Disruption of Ongoing Hospital Services• Significant Noise Control Disruption• Airbourne Particles / Infection Control Concerns• Site Accessibility during Construction• Vibration and its Effect on Hospital Services• Time and Scheduling Constraints



OBJECTIVE BENEFIT LOW SCORE CRITERIA 0 10 # HIGH SCORE CRITERIA

AFFORDABILITY

Site Availability High $ Cost 8 No Cost $ to BHB

Total Project Cost High Project $ Cost 1 Low project $ Cost

TIMELINESS

Schedule to Completion 15 years 6 5 years

Project Implementation Risk Delays 6 No Delays

QUALITY OF CARE

Impact on Current operations Disruptions 4 No Disruption

Impact on Patients Decreased Confidence/Use 6 Increased Confidence/Use

Programme Requirements Compromised 10 Meets Needs

EFFICIENCY

Functional Layout Compromised 8 Preferred

Future Flexibility No Flexibility 8 Easily Expanded/Renovated

Movement Long Travel Distances 8 Short Travel Distances

DESIGN IMAGE

Site Image Negative Impact 9 Positive impact

Building Image Institutional 8 Healing Environment

FINANCE

Revenue Potential Lost Revenue 5 Increased Revenue

Operational Costs Increased Costs 5 Decreased Costs

Ability to Fundraise Status Quo/Long Delivery 7 New Image/Timely Delivery

PUBLIC ACCEPTANCE

BHB Staff Low Acceptance 2 High Acceptance

General Public Low Acceptance 7 High Acceptance

External Agencies/Gov't Low Acceptance 10 High Acceptance

Physician Community Low Acceptance 5 High Acceptance

TOTAL 45 MAXIMUM SCORE (70)

8.00

8.50

5.67

6.00

4.50

6.00

6.67

SCORE



3. Acute Care Hospitalb. Evaluation / RecommendationPublic OpinionPublic forums were held with BHB staff and General Public in June 2005 (two staff forums andsix public forums). Surveys were conducted (via website, at the public forums and via telephone)to gauge public opinion for each of the three options. Support was greatest for remaining at theKing Edward VII Memorial Hospital site despite the many challenges and risks that would beassociated with this option.


Support for Developing Campuses of Care Percent of those in Favour

Staff Forum Surveys 100%

Public Forums 98%

Phone Surveys 80%

Preference for Acute Care Hospital Site Percent of those in Favour

Staff Forum Surveys 51% favour Arboretum

Public Forums (Week 1) 67% favour Arboretum

Public Forums (Week 2) 67% favour KEMH

Public Forums (Week 3) 85% favour KEMH

Phone Surveys 70% favour KEMH

3. Acute Care Hospitalb. Evaluation / RecommendationQualitative Risk AssessmentIt is important to note that there are considerable risks associated with building the new hospitalon the existing site:

• Disruption of Ongoing Hospital Services - The potential disruption to ongoing HospitalServices cannot be underestimated. All services to the existing hospital will have to beprovided with redundant power servicing to minimize the potential for utility loss due todemolition of adjacent structures. Certain procedures may need to be curtailed or limited tocertain time periods to minimize risk to patients.

• Significant Noise Control Disruption - Given the current identified schedule, the KEMH sitewould be under construction for between 7-9 years, both for the construction of the new hospitaland the deconstruction of the existing hospital once the new hospital is open. Constantnoise will be an issue for patients (quality of care) and will be disruptive to staff. Certainprocedures that are noise sensitive will either be limited to specific time periods, or constructionwill have to be limited during hours of operation (this will increase capital costs and potentiallylengthen the construction period).

• Airbourne Particles / Infection Control Concerns - Infection Control is a significant issue inall hospitals today independent of a hospital that is immediately adjacent to a constructionsite. From the Comprehensive Strategic Review, issues with regards to Infection Controlhave already surfaced, these will be compounded many times over during construction.Detailed protocols/additional staff may be required to combat airbourne particles (dust anddirt) which will inevitably be tracked into the facility and through openings / mechanicaldistribution. This may involve additional filters/changing of filters, and additional environmentalservices staff to undertake additional housekeeping.

• Site Accessibility during Construction - The western half and the northern edge of the existingKEMH site will be a construction zone and access to the Hospital will largely have to occurfrom Berry Hill Road. The ability for access and to drop off near the current entrance whilestill viable may prove difficult with the anticipated congestion on the site. Consideration mayneed to be given to providing an expanded shuttle service to the Hospital front door forpatients who need to either park on the watercatch or in the temporary parking at the Arena.

• Vibration and its Effect on Hospital Services - With construction occurring on the west andnorth sides of the existing Hospital within 10m, there will be issues of vibration transfer bothduring demolition and construction. This may restrict certain diagnostic equipment to only beused during set time periods and may necessitate additional calibration.

• Time and Scheduling Constraints - It is not uncommon for Hospitals to provide expanded hoursof service to compensate for the limitations that construction places on the ability to provideongoing services. This may mean expanding certain service lines into the evening or on weekends.


3. Acute Care Hospitalb. Evaluation / RecommendationCapital Cost Estimate

(a) Financing costs excluded(b) All costs are in Bermudian dollars


ItemArboretum

$

BotanicalGardens

$

King EdwardMemorialHospital

$

Acute Care Hospital 470,380,000 468,874,000 505,846,000

Medical Office Building 40,968,000 40,968,000 40,968,000

Mental Health 70,054,000 70,054,000 70,054,000

Continuing Care - East Campus 27,767,000 27,767,000 27,767,000

- West Campus 31,073,000 31,073,000 31,073,000

- Central Campus 16,677,000 16,677,000 16,677,000

Staff Housing 28,601,000 28,601,000 28,601,000

Total Capital Cost (June 2005 dollars) $685,520,000 $684,014,000 $720,986,000


3. Acute Care Hospitalc. Recommended DirectionRecommendationUpon review of all of the factors that affect the delivery of quality healthcare to Bermuda, theProject Steering Committee firstly reinforced the original decision that the AR.A - “GardenTerrace” Replacement Hospital Option would best serve the long-term needs of healthcare,but secondly recognized that time is of the essence, and due to considerable public oppositionto using any parkland for a hospital site, that the prudent decision would be to develop theKE.C - “Crescent” Replacement Hospital on the existing King Edward VII Memorial Hospital Site.In late June 2005, the Bermuda Hospital Board endorsed this recommendation.


3. Acute Care Hospitalc. Recommended Direction - King Edward VII Memorial Hospital SiteThe Steering Committee directed the Estate Master Plan Team to further develop the preliminaryplanning and design concepts for placing the new Acute Care Hospital on the existing KEMHsite with the following modifications:

• Explore ways to accelerate the implementation schedule

• Eliminate the Parking Structure to the East

• Provide access to Emergency from Point Finger Road rather than Berry Hill Road

Planning revisions have been made to the Estate Master Plan document to reflect these changes.

By placing the Parking Structure beneath the Acute Care Hospital, the site that was originallyallocated for the multi-storey parking deck now becomes a future development parcel. Initiallythis large area could be utilized as additional open space as well as specialty surface parkingfor the adjacent Women's Center. In the future, the area could become the site for new buildingprogrammes, new expansion parking structure, or, in conjunction with a portion of the BotanicalGardens, a future replacement hospital site in 40+ years.

These modifications also allow for the acceleration of the implementation schedule by 2 years,since demolition of the existing hospital is not necessary for accommodating the 2015 programmeneeds. However, unless a timely decision regarding the relocation of the existing ContinuingCare Facility and Nurses Residence (required for gaining access to the proposed Acute CareHospital site) is made, the 2 year project advancement would not be realized.

Since the Acute Care Hospital is built into a sloping site, both the Ground Level and First Levelhave immediate access to grade. In the revised plans, the organization concept for the buildingwas modified so that the Diagnostic areas occur on the Ground Level and the Clinics on Level1. As a result, Emergency now has direct access from Point Finger Road by way of the existingcurb cut and road that is used to access the current Continuing Care Facility. The existingentrance road from Point Finger Road continues to serve as the main hospital entrance access,with a secondary point of entry from the existing curb cut on Berry Hill Road.


3. Acute Care Hospitalc. Recommended Direction - King Edward VII Memorial Hospital Site

Site Plan


3. Acute Care Hospitalc. Recommended Direction - King Edward VII Memorial Hospital SiteLower Levels 1 & 2

• Lower Levels 1 & 2 are subterranean and provide parking on each level.

Ground LevelGround Level is configured to provide diagnostic hub along front/public leg of the "L" shapedplan while Support Services are consolidated in the “back” leg of the new "L" shaped facility.

• On this level designated external access for the Emergency Department is provided, separatedwalk-in patients and ambulance traffic from general site traffic to a designated zone; with separatewalk-in and ambulance entrances.

• Interior circulation is managed by two distinct parallel corridors separating outpatients andpublic from acute patient and clinical support circulation areas. As well as zone the diagnosticareas from the administrative areas.

• The Diagnostic Hub consolidates Imaging/Radiology, Surgery and Cardiology in one locationis located immediately adjacent to Emergency Services. Procedure areas and the mainSurgery Suite is developed on the concept of a flexible zone where related Diagnosticservices may be developed to cross-utilize procedure space as patient acuity and technologyenable this concept. (i.e. future Invasive Cardiology). Sterile Processing is located directlyadjacent to the Surgery Suite and is connected by an internal corridor.

• This plan also provides future expansion space to accommodate future services. (i.e.Radiation Oncology and a designated outpatient entrance for future growth.)

• Support Services included towards the back of facility with a designated service entranceinclude: Material Management, Laundry, Environmental Services, Pharmacy, Bulk Storage,Facilities and Bio-Med are located on a service corridor. The Central Utility Plant is also locatedhere.


• Laboratory/Pathology is located on this level with convenient access to the exterior forcourier access. The morgue function is consolidated/attached to the Lab/Pathology, with accessto the dock area. Elevators and pneumatic tube will connect the Laboratory and Pathologyto all intake and diagnostic services, and inpatient units.




Ground LevelLower Level 1 & 2

3. Acute Care Hospitalc. Recommended Direction - King Edward VII Memorial Hospital SiteLevel 1The Level 1 provides consolidated outpatient services along the public building face and providesadministrative services on the perimeter of this level.

• Upon entry, high volume Outpatient Services and Public/Education service visitors are peeledoff from the main lobby; other patients and visitors utilized designated elevators providingdirect access to the Diagnostic Hub and the inpatient units.

• Food Services may have a designated delivery area if desired; the staff dining area isaccessed off the general use corridor.

• Medical Staff facilities and clinical staff support areas are located off of the general/staffcorridor convenient to a staff entry point.

• Administrative services on the perimeter of each leg of the "L" shaped plan include: ExecutiveAdministration, Health Records, Information Services. Human Resources and EmployeeHealth and Finance, Home Care and Quality Assurance & Risk.

• The Chapel is located convenient to Emergency Department, Surgery, and ICU.

• The main public concourse connects to the future MOB.

Level 2• All inpatient beds are accommodated on one level.

• Typical inpatient units are planned based on a 32 bed unit model.

• Intensive Care Unit is vertically connected to the Emergency, Surgery Suite and diagnosticszone for direct transport of the most critical patients.

• Surgical Unit is located with convenient access to elevators serving the Surgery Suite.

• The Rehab Unit is located above the Rehab/Physiotherapy Department; and adjacent to theSurgical Unit; Rehab may flex to accommodate Surgical unit overflow as needed.

• Two Medical Units are provided; they are located above the diagnostic hub.

• Maternity and Pediatrics is located in a separate pavilion with distinct separation from thegeneral Medical/Surgical units; develop identity for Women's Services Centre.

• The Support Service corridor is configured for discreet distribution of supplies to the facilitywithout mixing traffic with patients and public users.

Level 3• Administrative space for the Ministry of Health is located in the pavilion setting.




Level 2Level 1 Level 3



4. Campuses of Care


Central Campus

West Campus

East Campus

The development of "Campuses of Care" is a critical component to achieving a comprehensiveEstate Master Plan that addresses the total continuum of care for the citizens of Bermuda.Significant benefits of this “satellite facilities” approach include:

• Healthcare delivery is expanded throughout the island

• Services are closer to the patients, family, and caregivers

• Dispersed facilities can better respond to potential natural disasters

• Routine medical care can be provided outside of an "Emergency" environment

• Continuing Care Facilities are better suited in a community setting

• Group Homes are better suited in a community setting

Three sites were identified for further development evaluation:

• Central Campus - Mid-Atlantic Wellness Institute Site

• West Campus - Port Royal Site

• East Campus - Southside St. David's Site

4. Campuses of Carea. Central SiteThe Central Campus of Care will be developed on the Mid-Atlantic Wellness Institute site thatis owned by the Bermuda Hospitals Board. Currently, the Mental Health Hospital has excessspace, a phasing plan can be implemented that would allow for construction of the newreplacement hospital to the north of the main building complex. Once completed, the balanceof the existing hospital buildings can be demolished. The new site that is created will besufficient in size to accommodate a 72-bed Continuing Care Facility, a cluster of Mental HealthGroup Homes for 60 patients, and a Primary Care Centre.

The site will also be developed to include an outdoor recreation area that can be utilized by thecommunity as well as the Mid-Atlantic Wellness Institute patients. Tree buffers and resident gardenareas will help to transition the existing site from an institutional setting to a neighborhoodcommunity.


4. Campuses of Carea. Central Site


Mid-AtlanticWellness Institute

Continuing Care

Group Homes

Primary Care

4. Campuses of Careb. West SiteThe West Campus of Care should be developed on property central to Barnes Corner andSomerset Village. One concept site selected, owned by the Bermuda Land DevelopmentCorporation, located near Port Royal in order to test the programme fit with the size of theproperty. Part of this property has also been identified as a potential site for Senior Citizens'Housing.

This potential site would be sufficient in size to accommodate a 72-bed Continuing Care Facility,a cluster of Mental Health Group Homes for 60 patients, and a Primary Care / Wellness Centre.The proposed location adjacent to the potential Senior Citizens' Housing development wouldbe very appropriate and assist in the creation of a community neighborhood character.


4. Campuses of Careb. West Site


Primary Care

Group Homes

Continuing Care

4. Campuses of Carec. East SiteThe East Campus of Care would ideally be developed on property central to the Swing Bridgeat Kindley Field Park and north of the Airport along St. David's Road. A potential concept siteselected, owned by the Bermuda Land Development Corporation, that is located adjacent to White'sGrocery Store in order to test the programme fit with the size of the property.

This potential site would be sufficient in size to accommodate a 72-bed Continuing Care Facility,a cluster of Mental Health Group Homes for 60 patients, and a Primary Care / Wellness Centre.The proposed location adjacent to White's Grocery Store and other Senior Housing in thegeneral area would be very appropriate.


4. Campuses of Carec. East Site


Primary Care

ContinuingCare

Group Homes


5. Mid-Atlantic Wellness Institute

The new Mid-Atlantic Wellness Institute will be located along the ridge line on the north quadrantof the site. The patient wings will flank the existing manor house and auditorium. Main arrivalwill be from the north, rising up to the existing manor house with visitor parking next to theentry. The bowl shaped open space created by this organization can be used for recreationalpurposes by the facility occupants and the adjacent community alike. The existing salvaged buildingswill be renovated to create interior and exterior common spaces. A central circulation streetlinks all the major programme components to the main entry. Outpatient services are benchedunder the main level and have a separate arrival at grade on the south side of facility. Verticalcirculation between the two levels will be centrally located to minimize security issues andsupport a simple clear circulation system. All the patient units will have secure and dedicatedexterior courts for treatment and recreation. The primary orientation of all the patient units andtheir courtyards is to the south with panoramic ocean views. The efficient use of the sloped sitecreates a low one storey massing effect that helps wed all interior spaces directly to the landscapesurrounding it.


5. Mid-Atlantic Wellness Institute



Ground LevelLower Level


6. Continuing Care Facilities

The Continuing Care Facilities will be single storey, twelve bedroom units with the amenities ofhome that will include a separate Living Room, Kitchen, Dining Room and Laundry. The 12-bed units will be arranged on the various sites around resident gardens. The concept is toprovide as much long-term flexibility as possible; units might be used for Dementia populationone year, as a step-down unit or as a continuing care unit. The “House Concept” provides a non-institutional atmosphere, while at the same time permitting the standard of care required by thepatient. The goal is to provide residents with as much normalcy as possible; replicating theenvironment familiar to them. Each of the Campuses of Care could accommodate up to 72beds.


Central Campus

West Campus

East Campus


7. Staff Housing

The Bermuda Hospitals Board (BHB) currently provides a variety of staff housing to address theneeds of ex-patriate staff members. The current housing stock consists of several houses andthe Queen Elizabeth Nurses Residence. The latter is not suitable due its physical configurationand building condition. It is also located on the King Edward VII Memorial Hospital site wherethe new hospital is planned to be located.

Initial BHB housing requirements indicated a need for 10-12 private 3 bedroom and (2) bedroomdwellings; 25 - Single bedroom dwellings; 36-studio type dwellings; and a potential 12 bedguesthouse type structure for use by consultants and others servicing the Bermuda HospitalsBoard properties and facilities. A dwelling in this context is any individual unit containing adesignated kitchen and bathroom facility, regardless of the number of bedrooms or other livingspaces.

The site designated for housing was the parcel of property known as the Water Catch, andparking facility immediate north of the existing Nurses Residence on Berry Hill Road. The siteconsists of 3.7 acres (133,648 square feet). The site development profile is a south facing hillwith elevations of 24 Metres (78' Above Sea Level) up to 46 Metres (150'Above Sea Level) atthe highest northerly point. The site is bounded by residential structures, except at thesoutheastern corner where a former residence has been redeveloped for a Doctors' Offices.

The BHB Estate Master Plan doers not address the redevelopment or potential upgrades of existingoff site residential structures currently occupied by BHB staff.

The Bermuda Plan 1992 Planning statement designated this parcel as Residential 2 withallowable site development and coverage of 20 % for single dwellings and for attached 2 storeytype structures. The Plan does not allow multi-level apartment structures within this Residential2 Zoning. Given the single dwelling residential development pattern of the surrounding propertiesand due to the development limitations of the Planning statement for this parcel, the design teamopted for the maximum number of dwellings with the greatest occupancy allowable.

The greatest housing need is for nursing staff and doctors with families. The plan presented favorsfulfilling the 3-Bedroomm dwelling unit requirements. These units were seen as a more flexibleprogramme response given the Planning regulations for this property. These units may beutilized for single families or for multiple co-renters. At this time in Bermuda where accommodationis at a premium, many adults will co-share a 3-bedroom dwelling. It is with this design criteriain mind the development plan Housing options is presented for review and confirmation.

4.7.1ESTATE MASTER PLAN - RECCOMENDATIONS REPORT

7. Staff Housing

The development option presented consists of 3 types of 2 storey structures. These consist ofthree bedroom structures above and either a one bedroom or studio dwelling below for types‘A'& 'B'. Type ' C ' consists of two bedroom units at the upper and lower levels. (3) Bedroom unitsare 1,290 square feet; (2) bedroom units are 1,080 square feet; (1) Bedroom units are 765square feet; and the Studio units are 540 square feet. There are a total of 8-Three bedroom dwellings,4-Two bedroom dwellings, 4-One bedroom dwellings, and 4-Studio dwellings

The units types are assemble in pairs and in 5 locations on the site. Each location has sufficientamenity garden space as well as nearby moped parking. Car Parking is also allowed for howeverit is anticipated that given the relative proximity to the hospital, few residents will require an automobile.A resident's swimming pool and barbeque area is centered on the site - an amenity seen as anadditional perk for staff, and an incentive for attracting and retaining capable staff.

The planning development criteria allows for a carefully designed grouping of residentialstructures and complimentary amenities that mirror adjoining development types, while retainingapproximately 1/3 of the property for continued use as an overflow parking facility for hospitalstaff. As noted earlier a Ministerial Special Development Order may provide opportunity foradditional density to be developed on this site, however trying to addressing all of the BermudaHospital Boards housing needs on this site will be problematic unless a vertical high risedevelopment in this area is considered acceptable by the community.

Density of the site is restricted due to current zoning. We would recommend that within anapplication for a Special Development Order for the entire Project, the density of the site be increasesto allow for 3 floor walk up type accommodations. Types and sizes provided are as follows:

4.7.2 ESTATE MASTER PLAN - RECCOMENDATIONS REPORT

Unit Type Area (sq ft) # of Units

Studio 540 4

1 Bedroom 765 3

2 Bedroom 1080 3

3 Bedroom 1290 8

Total 18

Residential Housing Type C

7. Staff Housing

4.7.3ESTATE MASTER PLAN - RECCOMENDATIONS REPORT

Residential Housing Type A and B

First FloorFirst Floor

Ground Floor Ground Floor

4.7.4 ESTATE MASTER PLAN - RECCOMENDATIONS REPORT

8. Project Implementation

The critical path schedule outlined in this report reflects the anticipated timelines for implementingthe Estate Master Plan. All of the components would be completed by the end of 2014, withthe majority of the New Acute Hospital completed towards the end of 2012. It should be notedthat this schedule is based on timely decisions by all parties.

The Planning and Design phases for the proposed scope of work are expected to continue tothe end of 2007. Pre-Design Services are scheduled to begin no later than January, 2006.Facilities Design will occur during 2006 and 2007.

This section should be read in conjunction with Price Waterhouse Cooper's Estate Master PlanBusiness Case. There are a number of potential opportunities to streamline and shorten theimplementation process. This will require a detailed examination of interim solutions forContinuing Care and Staff Housing. Costs (both capital and financing) could be reduced as aresult.



2016201520142013201220112010200920082007200620052004

Planning & Design

Estate Master Plan

Pre Design Services

Facilities Design

Implementation



Relocate Nursing Residence

Demolish Cont.Care, C.U.P.

& Nursing Residence

Acute Care Hospital



Rework Plant Connections

Demolishing Existing Hospital




Capital Cost Estimate

The Capital Cost Estimates presented in this report are intended to provide a realistic assessmentof the direct and indirect Capital Cost for the implementation of Bermuda Hospitals Board (BHB)Estate Master Plan study as completed by Cannon Design and their sub-consultants.

It should be noted that the construction cost estimates are based on a Pre-schematic andMaster Facilities programme documents and are not a completed set of working drawings thatwould be utilized by a contractor to bid the project. The estimates provide reasonable costenvelopes within which facility designs can be developed. Further cost estimates based on moredetailed design and engineering information may vary from this baseline estimate.

The current estimated Capital Cost for the Preferred Option developed by Cannon Design andtheir sub-consultants is as follows:

(a) Financing, Escalation & Risk costs excluded(b) All costs are in Bermudian dollars

SiteProject Cost (June 2005)

$ Schedule

Completion

Acute Care Hospital 505,846,000 2014

Medical Office Building 40,968,000 2011

Mental Health 70,054,000 2011

Continuing Care - East Campus 27,767,000 2014

- West Campus 31,073,000 2012

- Central Campus 16,677,000 2009

Staff Housing 28,601,000 2014

Total Capital Cost (a&b) $720,986,000 2014



Program KE.C BG.B AR.A Baseline

Diagnostic Services 49,635,379 44,982,062 44,982,062 38,777,640

Ambulatory Services 2,769,254 2,509,637 2,509,637 2,163,480

Inpatient Services 26,805,504 24,292,488 24,292,488 20,941,800

Administrative Services 2,600,294 2,356,517 2,356,517 2,031,480

Support Services 4,519,680 4,095,960 4,095,960 3,531,000

Total $86,330,112 $78,236,664 $78,236,664 $67,445,400

Notes:1. Baseline Estimate generated by assigning current cost estimates to Cannon Design's BHB Programme dated May 31, 2005.

2. Options BG.B and AR.A reflect Baseline and 4yr of 4% (16%) escalation due to projected 2009 completion.

3. Option KE.C reflects Baseline and 7yr of 4% (28%) escalation due to projected 2012 completion.

Project Equipment and Furnishings Budget


Departmental Equipment and Furnishings Budget

DEPARTMENT: EMERGENCY

Room #: ED001Room Name: TREATMENTPRN: 385_00001

New Equipment

Description Manufacturer Model PEN Unit Est. CostChair, Patient Side 385_00014 Each $450.00Chair, Patient Side 385_00015 Each $450.00Clock, Discrete 385_00013 Each $40.00Curtain, Cubicle 385_00012 Each $550.00Dispenser, Glove Box, Triple Health Care Logistics 7467-01 385_00018 Each $40.00Disposable Unit, Needle (Sharps) Kendall Healthcare 851301 385_00003 Each $50.00Flowmeter, Air 385_00017 Each $50.00Flowmeter, O2 385_00006 Each $50.00Light, Exam, Ceiling Mount Steris Examiner 10 385_00002 Each $2,700.00Monitor, Physiologic, Hardwired TBD TBD 385_000010 Each $15,000.00Rack/Panel, Bin, 35Wx20Hx11D Health Care Logistics 1425 385_000011 Each $150.00(Bins), Wall MountRegulator, Vacuum 385_00004 Each $650.00Sphygmomanometer, Oto/Ophth Welch-Allyn 76797-2P 385_00016 Each $1,200.00Oto Dispenser, Therm, IntegralUnit, Wall MountStool, Physician 385_00007 Each $350.00Stretcher Stryker 1210 385_00001 Each $4,000.00TV Mounting Bracket, 13” Peerless SWM 314 385_00008 Each $150.00TV Set, 13” Philips HC9913C 385_00005 Each $325.00Waste Receptacle, Non-Hazardous Rubbermaid TBD 385_00009 Each $50.00

Room Total $26,255.00




DEPARTMENT: IMAGING

Room #: IM001Room Name: RADIOGRAPHIC ROOM/GENERALPRN: 385_00002

New Equipment

Description Manufacturer Model PEN Unit Est. CostAllowance to provide Lead Aprons 385_00112 Each $2,000.00Dispenser, Glove Box, Triple Health Care Logistics 7467-01 385_00035 Each $40.00Disposable Unit, Needle (Sharps) Kendall Healthcare 851301 385_00022 Each $50.00Flowmeter, Air 385_00024 Each $50.00Flowmeter, O2 385_00027 Each $50.00Hamper, Linen 385_00023 Each $125.00Immobilizer, Portable, Chair TBD TBD 385_00031 Each $2,500.00Immobilizer, Portable, Cradle TBD TBD 385_00032 Each $1,500.00Pole, I.V. 385_00037 Each $200.00Rack, Apron, X-Ray, Peg Style Bar Ray Products 60081 385_00021 Each $300.00Radiographic/Flouroscopic Unit Philips Medical Optimus 385_00019 Each $450,000.00General SystemsRegulator, Vacuum 385_00025 Each $650.00Stool, Step 385_00026 Each $125.00Table, Instrument, Procedure 385_00036 Each $500.00TV Mounting Bracket, Platform Peerless WLWB 530T 385_00020 Each $150.00Style, Wall MountTV Set, Flat Panel, 20” NEC LCD2010 385_00030 Each $1,200.00VCR/DVD Panasonic PV-D4752 385_00038 Each $250.00Waste Receptacle, Contaminated 385_00029 Each $85.00Waste Receptacle, Non-Hazardous Rubbermaid TBD 385_00028 Each $50.00

Room Total $459,825.00

Department Total $459,825.00




DEPARTMENT: SURGERYRoom #: SUR001Room Name: OPERATING ROOMPRN: 385_00004

New Equipment

Description Manufacturer Model PEN Unit Est. CostAnesthesia Machine Datex/Ohmeda Aestiva 3000 385_00064 Each $60,000.00Cabinet, Supply Storage Continental Metal TBD 385_00113 Each $2,600.0048Wx18Dx72H, Glass Doors, w/ Products

Sloped Top and 12” BaseCabinet, Supply Storage Continental Metal TBD 385_00070 Each $2,600.0048Wx18Dx72H, Glass Doors, w/ Products

Sloped Top and 12” BaseCabinet, Supply Storage Continental Metal TBD 385_00114 Each $2,600.0048Wx18Dx72H, Glass Doors, w/ Products

Sloped Top and 12” BaseCabinet, Warming, Single Steris DJ03 385_00066 Each $4,450.00Compartment, Wall Mount, ElectricCart, Anesthesia, Supply 385_00073 Each $1,500.00Cart, Gas Cylinger, Single 385_00074 Each $150.00Cart, Surgical Case 385_00078 Each $2,700.00Cart, Surgical Case 385_00076 Each $2,700.00Cart, Surgical Case 385_00075 Each $2,700.00Cart, Surgical Case 385_00077 Each $2,700.00Clock, Discrete 385_00072 Each $40.00Column, Medical Gas, Anesthesia, Amico Alert 1 385_00109 Each $5,500.00

Telescoping, Stainless Steel, Ceiling Mounted





New Equipment

Description Manufacturer Model PEN Unit Est. CostColumn/Boom, Service Medical Steris CS6002 w/ PES 385_00069 Each $24,000.00Gas/Electrical, Surgical Field,

Articulating Dual Arm w/ Smoke Evac., Ceiling Mount

Electosurgical Unit 385_00079 Each $11,000.00Flowmeter, Air 385_00080 Each $50.00Flowmeter,O2 Precision Medical 385_00081 Each $50.00Hamper, Linen 385_00082 Each $150.00Hamper, Linen 385_00110 Each $150.00Hypo/Hyperthermia Unit 385_00083 Each $0.00Instruments, Surgical 385_00071 Each $80,000.00Kick Bucket, Procedure 385_00084 Each $150.00Kick Bucket, Procedure 385_00107 Each $150.00Light, Surgical, Dual Head w/ Steris Harmony LA 500/500 385_00068 Each $42,000.00

Monitor Arm and CCTV in w/ FP ArmLighthead

MIS FIberoptic Equipment 385_00108 Each $60,000.00(excluding scopes)

Monitor, Physiologic, (sits on Datex/Ohmeda As/3 385_00085 Each $40,000.00anesthesia machine)

Music System, CD Player w/ TBD TBD 385_00067 Each $2,000.00Ceiling Speakers

Pole, I.V. 385 _00087 Each $200.00





New Equipment

Description Manufacturer Model PEN Unit Est. CostPole, I.V. 385_00088 Each $24,000.00Pole, I.V. 385_00086 Each $24,000.00Regulator, Vacuum w/ Bottle Trolly N/A 385_00089 Each $24,000.00Stand, Mayo, Large 385_00090 Each $500.00Stand, Mayo, Medium 385_00091 Each $500.00Stand, Solution/Basin, Single 385_00093 Each $350.00Stand, Solution/Basin, Single 385_00092 Each $350.00Stool, Pneumatic 385_00095 Each $350.00Stool, Pneumatic 385_00094 Each $350.00Stool, Step, Stacking 385_00096 Each $175.00Stool, Step, Stacking 385_00097 Each $175.00Stool, Step, Stacking 385_00098 Each $175.00Stool, Step, Stacking, 30W 385_00099 Each $175.00Stool/Chair, Pneumatic, Anesthesia 385_00100 Each $350.00Stool/Chair, Pneumatic, Nurse Chart 385_00101 Each $350.00Table, Instrument, Prepw/Rail, 385_00102 Each $400.00

20Wx16DTable, Instrument, Procedure 385_00103 Each $500.00Table, Instrument, Procedure 385_00104 Each $500.00Table, Surgical, Portable Skytron 6005 385_00089 Each $45,000.00Transfer Device, Patient Roller 385_00105 Each $300.00Waste Receptacle, Contaminated, 385_00106 Each $150.00

Hamper StyleRoom Total $401,840.00

Department Total $401,840.00



9. Next Steps

The Estate Master Plan as described in these documents does not represent a final detailedprogramme, organizational plan, or design concept. It outlines the new and exciting vision anddirection that the Bermuda Hospital Board (BHB) will use to guide the future development of amore integrated healthcare delivery model for the citizens of Bermuda.

We have outlined a schedule that will allow the BHB to present the details of the Estate MasterPlan to various Government agencies/representatives over the next 4 - 6 weeks in order togain the necessary support for its implementation. With Government approval of the Estate MasterPlan, the following critical next steps (a 13 month process as outlined) must be undertakenbefore final design can commence:

1 Determine where the Continuing Care Facility and Nurses Residence can be relocated

The development of the Acute Care Hospital on the existing King Edward VII Memorial Hospitalsite is contingent on the relocation of the existing Continuing Care Facility and Nurses Residencein order to gain access to the site for construction. Work can not begin on the new building untilthe proposed site is cleared. A timely decision regarding the relocation sites, project fundingsource, and operational/ownership model is extremely critical to implementing the Estate MasterPlan schedule.

2 Evaluate Alternative Operational Models within an integrated healthcare system

Alternative operational models should be explored prior to finalizing the functional programme.These feasibility studies should include Materials Management (onsite or offsite facilities,purchasing practices, distribution systems and process), Laundry (onsite or offsite facility,potential expanded service to hotels), Food Services (onsite or offsite facility, production process,distribution system), Surgical Suite / SPD (scheduling, instrument standardization, inventorymanagement, case preparation process), Pharmacy (inventory management, informationsystems, dispensing). All other departments should also be reviewed for staffing, potential costsavings and other operational efficiencies. The final patient bed capacity plan should be studiedin more detail to determine if there is potential for reduction in the average length of stay andnumber of patient beds to be provided.


9. Next Steps

3 Develop a detailed room-by-room Functional Programme

Upon approval of the overall final direction (selected) plan for the BHB replacement hospital byBHB steering committee, it recommended that there is a series of concept development meetingsto review, discuss, and approve the individual functional zoning and space relationships asdefined in the concept plan with the overall staff of BHB (all departments). As preliminaryconcepts that have been generated to date, from feedback at BHB senior leadership, will nowneed further definition and most importantly consensus from not only from service line leadersbut also from users of each department and all related service representatives that support ordirectly interact with these areas. This is typically accomplished with a presentation to allhospital departments/staff and then a series (2-3) of scheduled work sessions with selectedrepresentatives to discuss department level concepts.

Upon establishing consensus and approval of the concept plan functional relationships asidentified above, the next step is programming and developing a detailed room by room functionaland space programme with a detailed room by room diagram to support the selected operationalmodel. This task will require establishing user groups, consisting of medical staff, departmentdirectors and associated staff, and senior management staff to define space and room by roomadjacency requirements. This is an iterative process requiring each group to meet in 3-5 worksessions to define service care model and delivery. As needed, it is advised to organize andschedule site visits to hospitals with different patient care delivery models for staff familiarizationand in defining the appropriate facility model for BHB. Based upon decisions made during theprogramming work sessions, the programme is the working document that includes a narrativedescription of approved operating concepts, staffing requirements, functional adjacencies, spacerequirements, and conceptual diagrams.

4 Prepare a detailed Risk Assessment study

There are considerable risks associated with developing a new replacement hospital on the existingKEMH site while keeping the current hospital operational. These include, but are not limited toboth quantitative and qualitative risks such as: Increased cost due to complexity and longerimplementation period, Increased exposure to construction escalation, disruption of ongoing hospitalservices, significant noise control disruption, airbourne particles and infection control concerns,site accessibility during construction, vibration and its effect on hospital services, and time/schedulingconstraints. The final design and project scope and budget will need to identify ways to minimizeor eliminate these risks.


9. Next Steps

5 Revise the Estate Master Plan concept designs based on the final programme

The current Estate Master Plan concept designs will need to be validated against more detailedprogramme development

6 Finalize the project scope and cost based on the final programme and design concept

More detailed cost estimates based on additional information will be required in order to finalizethe project scope.

7 Determine the final funding and procurement process

There are several ways to fund and procure these projects. A final evaluation will need to bedocumented and direction approved before proceeding with the final design.

The Estate Master Plan has been a diligent and very open and inclusive process. Multipleoptions were explored and reviewed with staff, physicians, agencies, government, and thegeneral public on numerous occasions. It is the desire of the BHB to continue the momentumand move quickly into the next phase of planning and design.


9. Next Steps

OctSepAug

Government Review/Approval

RFP (Pre-Design)

Pre-Design Services

Government Review/Approval

Estate Master Plan

RFP (Final Design)

Final Design Contract

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• Operational Alternatives

• Detailed Functional Programming

• Final Scope/Concept/Budget

• Continuing Care/Enabling Plan

• Funding/Procurement Alternatives

• Risk Assessment Study

• Schematic Design

• Design Development

• Contract Documents

MayMar AprFebJanDecNov Jun Jul Aug Sep Oct DecNov

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2005 2006

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